- Cardinal Health (Austin, TX)
- …care and timely access to necessary services + Assist in obtaining insurance, prior authorization , and appeal requirements and outcomes + Help patients ... understand their insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed + Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance +… more
- Humana (Austin, TX)
- …with UM leaders and clinicians to identify opportunities to implement electronic prior authorization technology, implement software rules to deploy the ... technology, and communicate with leaders throughout the process. 15% 4. Collaborate with UM leaders to develop process mapping for operational processes and offer recommendations for optimization and/or improvements. 15% 5. Assist with research, development… more
- Actalent (Dallas, TX)
- …utilization management and utilization review expertise. + Experience in concurrent review and prior authorization . + Knowledge in managed care and patient care. ... Additional Skills & Qualifications + Bachelor's or Associate's degree in Nursing. + Compact/Multistate Nursing License. + Strong multitasking and time management abilities. + Quick learning and adaptable attitude. + Computer savvy. Work Environment This… more
- Molina Healthcare (TX)
- …services to Molina members with ASD and other related disorders. * Approves prior authorization requests for BHT treatment by reviewing Behavioral Health Therapy ... (BHT) assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not limited to: Psychological Evaluation requests, Comprehensive Diagnostic Evaluations, Functional Behavioral Assessments, and Progress Reports.… more
- CVS Health (Austin, TX)
- …for clinical and legal review. + Provide day-to-day support and guidance for ABA prior authorization clinical team and the health plan medical directors. + ... Attend and participate in clinical meetings with care management and utilization management. Provide subject matter expertise on all ABA-related questions and member issues. + Support provider education initiatives for providers with a neurodiverse specialty… more
- Cardinal Health (Austin, TX)
- …cycle management specialists simplify and optimize the practice's revenue cycle, from prior authorization through billing and collections. **Job Purpose:** This ... position is responsible for the management and maintenance of the revenue cycle practice management system, including the accurate loading and mapping of fee schedules, effective CPT code management, the upkeep of the ICD-10 diagnosis directory, and insurance… more
- Molina Healthcare (Houston, TX)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + Requests additional information from members or providers in consistent and efficient manner. + Makes appropriate… more
- Cardinal Health (Austin, TX)
- …cycle management specialists simplify and optimize the practice's revenue cycle, from prior authorization through billing and collections. The **Revenue Cycle ... Management (RCM) Integrations Manager** plays a critical role in ensuring the smooth onboarding and operational integration of new oncology clinical practices into the MSO's centralized revenue cycle framework. This role is responsible for managing all phases… more
- Evolent (Austin, TX)
- …Managers to ensure successful adoption and engagement of Evolent's solutions (ie, prior authorization , clinical pathways) to ensure timely patient access to ... care and drive high provider satisfaction, measured by CSAT and NPS scores + Support the development and execution of innovative engagement opportunities such as regional clinical symposiums and local provider experience advisory panels + Own market level… more
- Prime Therapeutics (Austin, TX)
- …functions, DUR committees and responsibilities. + Supports elevated customer service and prior authorization inquiries specific to assigned accounts. + Manages ... financial aspects of account(s). + Ensures revenue goals are met, cost of care and administrative expenses managed, and EBIDTA targets achieved for the assigned account(s). + Ensures contract performance through risk management activities including such items… more